Justia Insurance Law Opinion Summaries

Porch.com is the parent company of Homeowners of America Insurance Company (HOA), which entered into an agreement with Gallagher Reinsurance (Gallagher) to serve as its reinsurance broker. Gallagher brokered a reinsurance deal for HOA involving Whiterock as the insurer and Vesttoo as a financier, with the understanding that China Construction Bank (CCB) would provide a letter of credit as collateral. Instead, HOA was only given a letter from Yu Po Finance stating a letter of credit would be forthcoming, which was never issued. Gallagher continued to assure HOA that the collateral was valid, leading HOA to authorize a substantial withdrawal by Vesttoo. When it was later revealed that Vesttoo’s collateral was invalid and CCB had never issued the promised letter of credit, HOA suffered financial harm, including increased costs for replacement reinsurance and regulatory intervention.The United States District Court for the Northern District of Texas heard Porch’s breach-of-contract claims against Gallagher, alleging violations of several sections of their agreement. The district court dismissed all of Porch’s claims with prejudice, finding that Gallagher did not breach the contract and that amending the complaint would be futile.On appeal, the United States Court of Appeals for the Fifth Circuit reviewed the dismissal de novo. The Fifth Circuit affirmed the dismissal of Porch’s claims under Sections 5 and 11 of the contract, concluding Gallagher had no duty to procure collateral documents from CCB or to comply with Texas insurance laws under the economic sanctions provision. However, the Fifth Circuit reversed the dismissal of Porch’s claim under Section 13, finding that Porch plausibly alleged Gallagher failed to perform administrative services customarily expected of a reinsurance broker after contract placement. The case was remanded for further proceedings on the Section 13 claim. View "Porch.com v. Gallagher Re" on Justia Law

Thomas T.D. Polk and his wife, Katarzyna Kurek-Polk, were struck by a vehicle while assisting another motorist, resulting in serious injury to Thomas and Katarzyna’s death. They recovered $100,000 from the at-fault driver’s insurance and sought additional compensation under three separate underinsured motorist (UIM) policies: $1,000,000 from AMCO Insurance Company, $500,000 from Progressive Northern Insurance Company, and $500,000 from Secura Supreme Insurance Company. Each policy included a proportionate liability clause and an “Other Insurance” anti-stacking provision, which limited the total UIM recovery to the highest coverage available under a single policy.After receiving $800,000 from the AMCO policy and rejecting a $220,000 offer from Secura, Polk filed a breach of contract suit against Secura and Progressive in the United States District Court for the Northern District of Illinois. The district court granted summary judgment in favor of the insurers. It held that the anti-stacking provisions were unambiguous and limited Polk’s maximum recovery to $1,000,000—the highest limit among the policies—regardless of the number of insureds or policies. Since Polk had already received $900,000 from the tortfeasor and AMCO, the court ordered Secura to pay $100,000 to bring the total to $1,000,000, and ruled that Progressive owed nothing.On appeal, the United States Court of Appeals for the Seventh Circuit affirmed the district court’s judgment. It held that the anti-stacking provisions in both the Progressive and Secura policies were clear and enforceable under Illinois law, and that the insurers’ liabilities were properly offset by the amounts already received, thus capping total recovery at $1,000,000. The court also rejected Polk’s arguments regarding policy ambiguity and statutory interpretation. View "Polk v Progressive Northern Insurance Company" on Justia Law

A woman was injured after slipping and falling in the parking lot of an automobile repair shop. She filed a claim with the shop’s insurance provider, which began covering some medical and wage expenses. After the insurance company’s representative informed her that liability for her claim was being accepted, the claimant ceased gathering evidence or seeking legal counsel, believing liability would not be contested. Over two years later, when settlement negotiations failed, she retained an attorney and sued both the repair shop and the insurer. After settling with the shop and dismissing it from the lawsuit, the claimant pursued multiple claims against the insurer, including breach of contract, promissory estoppel, spoliation, and equitable estoppel, contending that the insurer’s communications led her to detrimentally alter her conduct regarding evidence collection.The Fourth Judicial District Court initially indicated from the bench that the insurer was estopped from denying liability, but ultimately denied the claimant’s motion for partial summary judgment and granted summary judgment to the insurer on all claims. The District Court concluded that under Montana law as it existed before a 2023 statutory amendment, a third-party claimant could only bring statutory or common law bad faith claims against an insurer for mishandling a claim, and that the claimant had not sufficiently pled or could not prove the elements of her other asserted causes of action.The Supreme Court of the State of Montana held that, under the pre-2023 version of Montana law, third-party claimants are not restricted to statutory or common law bad faith claims and may assert other causes of action such as breach of contract or torts based on how an insurer handled a claim. The Court affirmed summary judgment for the insurer on promissory estoppel, breach of contract, and insufficiently pled claims, but reversed summary judgment on spoliation and equitable estoppel, remanding those claims for further proceedings. View "D'Hooge v. Cincinnati Insurance Co." on Justia Law

A tornado struck Goodhue County, Minnesota, damaging the roof of a mall owned by Rymer Companies, LLC. The roof had preexisting water damage, and the dispute centered on whether the insurance company, Cincinnati Insurance Company, was liable only for the tornado-related damage or for the cost of a full roof replacement, which was necessary to comply with local building codes. Cincinnati estimated its liability at about $10,000 for the tornado damage, while Rymer argued that a new roof was required, costing up to $1.7 million. After the parties could not agree, Cincinnati initiated a declaratory judgment action in federal court, and an appraisal panel awarded $23,226 for "mall roof repair."The United States District Court for the District of Minnesota initially concluded that any increased repair costs were Rymer’s responsibility, finding that the costs resulted from preexisting damage rather than the tornado. On appeal, the United States Court of Appeals for the Eighth Circuit held that it was sufficient if the tornado was a "but-for" cause of the county’s enforcement of the building code, and remanded the case for further proceedings, including clarification of the ambiguous appraisal award.Upon remand, the district court sought clarification from the appraisal panel as to whether the award covered repairs to the roof’s surface or just the flashing. The majority of the panel clarified that only flashing replacement was included. Rymer attempted to introduce later statements by the panel’s umpire to expand the scope of the award, but the district court held that such testimony is relevant only to allegations of panel misconduct, not to reinterpret or enlarge an award. The United States Court of Appeals for the Eighth Circuit affirmed this decision, holding that under Minnesota law, district courts may seek clarification of ambiguous appraisal awards, and that appraiser testimony cannot be used to expand or alter an award unless there is evidence of fraud or wrongdoing. View "Cincinnati Insurance Company v. Rymer Companies, LLC" on Justia Law

A Florida-based limited partnership invested in commercial real estate in Kentucky and purchased insurance for those properties from an insurer. The insured property suffered damage in March 2022, and the partnership promptly filed a claim. The insurer’s adjuster evaluated the damage, determined it was repairable, and offered to pay the cost of repairs minus a deduction for depreciation, explaining that the insured could recover the deducted amount after completing repairs. The partnership had purchased additional coverage that would pay for repairs “without deduction for depreciation” if repairs were completed within two years; however, at the time of the claim, the repairs had not been made.After rejecting the insurer’s offer, the partnership filed a putative class action in the United States District Court for the Southern District of Ohio, arguing that the insurer breached the policy by deducting depreciation from the repair-cost settlement. The insurer moved to dismiss the complaint for failure to state a claim. The district court granted the motion, finding that the policy allowed the insurer to deduct depreciation unless and until the insured completed repairs, at which point the depreciation could be recovered under the optional coverage.The United States Court of Appeals for the Sixth Circuit reviewed the case. The court held that, under Kentucky law and the specific terms of the policy, the insurer was permitted to deduct depreciation from the payment for repair costs because the insured had not yet completed repairs. The court found that the optional coverage only eliminated the depreciation deduction if the insured actually repaired the property, which had not occurred. The Sixth Circuit affirmed the district court’s dismissal, concluding that the insurer’s actions were consistent with the contract’s terms. View "Schoening Investment LP v. Cincinnati Casualty Company" on Justia Law

A pedestrian was fatally struck by a vehicle on a public roadway in Riverside, California. The decedent’s family sued the City of Riverside and others for wrongful death and dangerous condition of public property. In response, the City filed a cross-complaint against various contractors and their insurers, including Design Services, Inc. (DSI) and RLI Insurance Company (RLI). The City alleged that DSI had contracted to perform street lighting evaluations and upgrades, and that the contract required DSI to obtain insurance from RLI naming the City as an additional insured. The City contended RLI refused to defend and indemnify the City against the wrongful death lawsuit, despite its obligations under the policy.The Superior Court of Riverside County sustained RLI’s demurrer without leave to amend, finding that under Royal Globe Ins. Co. v. Superior Court, a plaintiff may not sue both the insurer and the insured in the same action. The court held that joining RLI in the same lawsuit as its insured, DSI, would risk prejudice by alerting the jury to the existence of insurance, in violation of California Evidence Code section 1155. The court dismissed the City’s cross-complaint as to RLI but allowed the City to pursue its claims in a separate action.The California Court of Appeal, Fourth Appellate District, Division One, reversed the judgment of dismissal. The appellate court held that the prohibition on joining an insurer and its insured in the same action does not apply when the City, as an additional insured, asserts its own contractual rights against RLI. The court found the City’s contractual privity with RLI distinguishable from the situation in Royal Globe and noted that any risk of prejudice could be addressed through severance or bifurcation. The case was remanded for further proceedings on the City’s claims against RLI. View "City of Riverside v. RLI Insurance Co." on Justia Law

A certified nursing assistant employed by a home health provider sustained injuries to her right shoulder and lower back during the course of her employment. She received medical treatment from several providers and was paid mileage reimbursements for traveling between patient homes. Following her injuries, the employer’s insurance carrier denied further payment of temporary disability and medical benefits, including an outstanding medical bill, and ultimately terminated her employment. The worker secured new employment at a higher wage and subsequently filed for workers’ compensation benefits, claiming entitlement to disability benefits and payment of the disputed medical bill. The employer denied liability.The Administrative Law Judge found that the worker had a compensable lower back injury with a 12% impairment rating, entitling her to temporary total and permanent partial disability benefits, but excluded mileage reimbursements from her average weekly wage and denied payment for the outstanding medical bill based on the provider’s failure to submit it within the statutory 45-day deadline. The Workers’ Compensation Board affirmed the ALJ’s findings. The Kentucky Court of Appeals affirmed the exclusion of mileage reimbursements and dismissed the issue of the unpaid medical bill as moot after the employer voluntarily paid it during the appeal. The Court of Appeals also rejected a motion for leave to file an amicus brief, deeming it unauthorized.The Supreme Court of Kentucky affirmed the exclusion of mileage reimbursements from the wage calculation, holding such payments were reimbursements for actual expenses and not “wages.” The Court reversed the dismissal of the medical bill claim as moot, applying the “voluntary cessation” exception, and held that denial of compensability constitutes reasonable grounds to excuse noncompliance with the 45-day rule for submitting medical bills. The Court also found the Court of Appeals erred in rejecting the amicus motion. The decision was affirmed in part and reversed in part. View "HARRIS V. MERCY HOME HEALTH" on Justia Law

Several insurance companies participate in Indiana’s Assigned Risk Plan, a statutory system designed to ensure workers’ compensation coverage for employers unable to obtain insurance in the voluntary market. One participating insurer, Technology Insurance Company, provided coverage under this system. After handling a significant workers’ compensation claim and settling for over $2 million, the company sought reimbursement from the Indiana Compensation Rating Bureau, as provided in their agreements. The Bureau denied reimbursement, alleging the company had acted fraudulently. The company followed the dispute-resolution procedures required by contract, ultimately securing a favorable ruling from an administrative law judge, who ordered full reimbursement. The company then sought additional relief—attorneys’ fees, interest, and expenses—from the agency, but received no response despite repeated requests.After payment of the principal settlement amount but no fees or interest, the company sought judicial review in the Marion Superior Court, which found the Department of Insurance’s failure to rule was arbitrary and contrary to law. The trial court ordered the Bureau to pay fees, interest, and expenses. The Bureau appealed, and the Indiana Court of Appeals reversed, holding the company’s claims for fees were not governed by the parties’ agreements and must be presented anew to the Bureau.The Indiana Supreme Court granted transfer, vacating the appellate court’s decision. The Court held that the company was required to exhaust administrative remedies, as set out in the Assigned Risk Plan and related agreements, but found the company had done so by pursuing its claims through the prescribed channels. The Court further held that the company was entitled to prejudgment interest, attorneys’ fees, and expenses under the contracts, and that these collateral claims could properly be added in the judicial review proceedings without further agency exhaustion. The judgment for the company was affirmed and the case remanded to the trial court for calculation and award of appropriate fees, interest, and expenses. View "Indiana Compensation Rating Bureau v. Technology Insurance Company" on Justia Law

Toy Quest Ltd. purchased an insurance policy from General Star Indemnity Company, which covered personal injury claims arising from certain specified torts, including malicious prosecution. When ASI, Inc. sued Toy Quest in federal district court in Minnesota for abuse of process, General Star agreed to defend Toy Quest under a reservation of rights but then filed a separate lawsuit seeking a declaratory judgment that it had no duty to defend against ASI’s claim. Toy Quest and ASI contended that the policy covered abuse of process, that California rather than Minnesota law should apply, and that the court should abstain from deciding the case until the underlying litigation was resolved.The United States District Court for the District of Minnesota granted General Star’s motion for judgment on the pleadings, holding that the policy did not cover abuse of process claims and that Minnesota law applied. The court also declined to abstain from hearing the declaratory judgment action and denied Toy Quest’s motions to certify the coverage issue to the Minnesota Supreme Court and to disqualify ASI’s counsel. Toy Quest and ASI appealed these rulings.The United States Court of Appeals for the Eighth Circuit affirmed the district court’s judgment. The court held that the district court did not abuse its discretion in declining to abstain, as the cases were not parallel and the federal court had jurisdiction. It further held that the insurance policy’s express coverage for malicious prosecution did not extend to abuse of process claims, as these are distinct torts under Minnesota law, and similar reasoning would apply under California law. The court also held that there was no actual conflict of law and denied the motions to certify and to disqualify counsel. View "General Star Indemnity Company v. ASI, Inc." on Justia Law

An individual purchased a long-term care insurance policy that covered expenses incurred at nursing or assisted living facilities. During the COVID-19 pandemic, at age 94, the insured fractured her hip and, due to concerns about contracting COVID-19 in a communal setting, received post-surgical care at home as prescribed by her physician. When she submitted a claim for these home health care expenses, the insurance company denied coverage, stating that her policy did not include home care benefits. The insured had selected a policy that covered only institutional care, though an alternative plan of care provision allowed for non-institutional benefits if certain conditions were met, including mutual agreement between the insured, her provider, and the insurer.The insured, through her successor trustees, filed a breach of contract action in the United States District Court for the Northern District of Illinois, Eastern Division. Both parties moved for summary judgment. The district court found in favor of the insurer, holding that the policy did not provide home health care benefits, and that the denial of coverage under the alternative plan of care provision was not in bad faith because the insured had not met the necessary conditions to trigger that provision.On appeal, the United States Court of Appeals for the Seventh Circuit reviewed the grant of summary judgment de novo. The court held that the policy did not provide for home health care benefits, as required for the relevant Illinois insurance regulation to apply. The court also determined that the alternative plan of care provision was discretionary and did not guarantee coverage for home care. Additionally, the insurer did not breach the implied covenant of good faith and fair dealing by enforcing the explicit terms of the policy. The Seventh Circuit affirmed the district court’s judgment. View "Hartnett v Jackson National Life Insurance Company" on Justia Law